State And Federal Tax Deduction Form - 2010
ADVERTISEMENT
1701 Camino de los Marquez
Santa Fe, NM 87505
(505) 827-8030 (505) 827-1855
fax
6201 Uptown Blvd. NE Ste. 204
Albuquerque, NM 87110
(505) 888-1560 (505) 830-2976
fax
State and Federal Tax Deduction Form
Please Print
Full Name
Social Security Number
Mailing Address
City
State
Zip
Phone No.
CHECK HERE if you are receiving a pension as a beneficiary.
Member’s Social Security Number:
Married
Married, but withhold at a higher single rate
Single/Widowed
**Please take into consideration other income not subject to withholding,
including social security income.**
FEDERAL Tax Deductions
STATE Tax Deductions
1. I do not wish to have federal tax deducted from
1. I do not wish to have State of New Mexico tax
my benefit.
deducted from my benefit.
2. I wish to claim (#) ______ allowances and have
2. I wish to claim (#) ______ allowances and have
NMERB determine the amount, if any to be
NMERB determine the amount, if any to be
withheld in accordance with the tax tables.
withheld in accordance with the tax tables.
3. In addition to #2 above, please withhold an
3. In addition to #2 above, please withhold an
additional amount of $___________ per month.
additional amount of $___________ per month.
4. Instead of withholding based on exemptions, I want
4. Instead of withholding based on exemptions, I want
the following amount withheld from each payment:
the following amount withheld from each payment:
Federal $________________________________
NM State $________________________________
I understand that this form supersedes any and all previous tax deduction forms. I have completed all
applicable fields in the Federal and State Tax Deductions sections of this form. I understand that if
insufficient taxes are withheld, I may be subject to a penalty by the Internal Revenue Service and the
State of New Mexico. I hereby submit this request regarding the treatment of my retirement benefit for
purposes of withholding Federal and State Taxes.
Signed _______________________________________________
Date _________________________
Please return this form upon completion to:
NMERB USE ONLY
New Mexico Educational Retirement Board
PO Box 26129
Effective Date:
Santa Fe, NM 87502-0129
By:
Revised 10/10
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form 37-s - Schedule Sf Computation Of Separate Income, Losses, Deductions, And Federal Tax Amounts To Be Used By Married Person(s) Required To File Separate State Return(s) Template (1999)
Financial
Form Rv-f1306901 - Sales And Use Tax Exempt Entities Or State And Federally Chartered Credit Unions
Financial
Form Rv-f1306901 - Application For Registration Sales And Use Tax Exempt Entities Or State And Federally Chartered Credit Unions
Financial
Related Categories
Parent category: Financial